The primary purpose of this study is to test the hypothesis of physician and nursing practice of pain management techniques will improve patient outcome (satisfactory and successful pain relief). The study will use feedback to practitioners. The monitoring will be conducted at a minimum of 3 institutions, at least one of which will serve as a control (on feedback), however elucidation on pain management will be provided at all sites. Demonstration that the addition of a feedback component results in improvement of patient outcome will provide a model which other institutions can use.